Prehospital emergency inguinal clamp controls hemorrhage in cadaver model.

BACKGROUND: The Combat Ready Clamp is indicated to stop difficult inguinal bleeding on the battlefield, the most common type of junctional bleeding and now the most common cause of preventable battlefield death. The purpose of the present study is to report the data of clamp development to help appliers use it correctly. METHODS: Wake Forest University investigators used a cadaver model to test the clamp's ability to control hemorrhage. Ten fresh cadavers were made to simulate inguinal and popliteal wound bleeding. Blood simulant was pumped to quantify device effectiveness in testing. Points of application included proximal pressure point control of popliteal, inguinal, and bilateral bleeding. RESULTS: Clamp use promptly controlled pulsing arterial hemorrhages from inguinal, popliteal, and bilateral wounds. The device, when placed on the common iliac artery, stopped all ipsilateral distal bleeding. CONCLUSIONS: The evidence of how the clamp works in the cadaver model showed that clamp use can plausibly be tailored to control inguinal hemorrhage from one wound, control two ipsilateral wounds with hemorrhage from one artery (e.g., common iliac artery), and control bilateral inguinal wounds (compression of the origins of bilateral common iliac arteries).

Functional and work capacity evaluation issues.

Functional capacity evaluation (FCE) may be defined as a systematic, comprehensive, and objective measurement of an individual's maximum abilities (ADL or work). The effect of the examinee's impairment on his or her ability to perform purposeful tasks is the focus of functional and/or work capacity evaluation (FCE/WCE). The common thread that connects all FCEs is the need for an evaluation of an individual with an unresolved residual. The forensic examiner must be able to determine the most suitable process from the 5 different types of evaluation processes involving functional capacity evaluations. The College on Forensic Sciences (CFS) has identified that most FCE administrators are not sufficiently grounded in science, case law and forensic issues. Examples may include misquoting standard journal articles and texts, making false statements, providing "junk science" opinions and interpretation, and deliberately omitting important facts and knowledge. In this day and age of managed care, cost containment of workers' compensation (fee schedules) claims, and economic incentives can change the position of the test administrators, therapists or providers. Through specialized training to better understand the requirements and needs of the courts, the forensic examiner can become a valuable tool in providing an "evidenced-based" opinion regarding FCE/WCE questions. This training should prepare the provider in FCE/WCE methods, forensic analysis and principles that have a reliable evidence-based reasoning and methodology that is scientifically valid.